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双重抗血小板治疗持续时间

Abstract

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Pooled Analysis of Bleeding, Major Adverse Cardiovascular Events, and All-Cause Mortality in Clinical Trials of Time-Constrained Dual-Antiplatelet Therapy After Percutaneous Coronary Intervention Six-month versus 12-month dual antiplatelet therapy after implantation of drug-eluting stents: the Efficacy of Xience/Promus Versus Cypher to Reduce Late Loss After Stenting (EXCELLENT) randomized, multicenter study Rivaroxaban Plus Aspirin in Patients With Vascular Disease and Renal Dysfunction: From the COMPASS Trial Does Risk of Premature Discontinuation of Dual-Antiplatelet Therapy Following PCI Attenuate With Increasing Age? Antibody-Based Ticagrelor Reversal Agent in Healthy Volunteers Genotyping to Guide Clopidogrel Treatment: An In-Depth Analysis of the TAILOR-PCI Trial A randomized comparison of Coronary Stents according to Short or Prolonged durations of Dual Antiplatelet Therapy in patients with Acute Coronary Syndromes: a pre-specified analysis of the SMART-DATE trial Acute Coronary Syndrome, Antiplatelet Therapy, and Bleeding: A Clinical Perspective
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Editorial2019;321(24):2409-2411.

JOURNAL：JAMA. Article Link

Dual Antiplatelet TherapyIs It Time to Cut the Cord With Aspirin?

KM Ziada; DJ Moliterno et al. Keywords: DAPT; 1-month clopidogrel vs. 12 month aspirin and clopidogrel; clinical outcomes; 3 years

ABSTRACT

Since evidence of increased risk of stent thrombosis with first-generation drug-eluting stents surfaced in 20051,2 and the US Food and Drug Administration advised interventional cardiologists to use dual antiplatelet therapy (DAPT) for 12 months following implantation of drug-eluting stents, the appropriate duration of DAPT has been widely studied and hotly debated. Dual antiplatelet therapy consists of concurrent administration of aspirin and a P2Y12 inhibitor. Determining the duration of DAPT requires a balance between 2 objectives: lowering the risk of ischemic events with more intense and longer antiplatelet therapy vs lowering the risk of bleeding events with less intense and shorter antiplatelet therapy. Because second-generation drug-eluting stents are associated with lower rates of stent thrombosis,3 the argument against longer DAPT was revisited. The updated guidelines incorporated such considerations by recommending a shorter duration of DAPT for selected patients, namely those with stable clinical status in whom risk of ischemic events is low.4,5

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